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TESTING FOR ALLERGY AND OVERLOAD

you came in on:
Miller's method

Sublingual testing and treatment
Hyposensitization
Patch testing
RAST test
Cytotoxic testing (ALCAT, Nutron etc.)

You have symptoms, you think it’s an allergy (hypersensitivity or intolerance) or overload and you want to know how you can be tested to establish what the problem is and what is causing it. What are the options?

The two main routes are:

  • conventional allergists and their immunological approach
  • alternative testing methods.

Conventional testing may be appropriate for you, if you have one of the very narrow range of allergies which can be detected this way: mainly these are Type I hypersensitivities (for skin scratch and antibody tests) or Type III and IV hypersensitivities (for patch testing). For reasons of completeness, an overview of these methods is included here. But the essential drawback of this route is that, at the end of the day, no matter what is found, you are going to get the same basic treatments: drugs and medicines. The conventional allergist has little else to offer you and, as they pompously pronounce in their own position papers, do not sympathize with the kind of self-help philosophy expounded in this book.

If you are seeking something more than just pharmacology, you may feel that taking this old-fashioned route is rather a waste of time. It’s up to you. You could of course try a combination approach and the next few sections might help you understand better what is being offered.

 

CONVENTIONAL ALLERGY TESTING METHODS

Prick or scratch tests and hyposensitization

The mainstay of conventional allergy test has not advanced significantly since 1911, when the prick and scratch test method was first developed. For this method a small drop of the substance being tested is dropped onto the skin, which is then scratched or pricked with a needle at that spot. The amount of flare and wheal compared to that caused by a control (inert) solution gives an indication of how allergenic the substance is (Noon L., Prophylactic Innoculation against Hay Fever, Lancet 1, London, 1911, p. 1572).

It is a very inaccurate method, with many false negatives, and subjects seldom react to food at all in this way, though a demonstrable allergy may be present on challenge testing. An important migraine study at the Great Ormond Street Hospital for Sick Children in 1983 showed that none of the cases would have recovered by following an exclusion diet based on the results of the prick testing included in the trial, though 93 per cent improved on a suitable diet, showing that food allergy was the cause (Egger J. et al. Is Migraine Food Allergy? Lancet, London, 15 Oct 1983, pp.865-8).

False negatives: are disastrous because you are misled into believing the substance is safe

False positives: are merely inconvenient, you avoid something unnecessarily, when it is quite safe

One final failure, which is not talked about: the substance with the largest reaction may NOT be the one which is causing you the most trouble, as I have found out many times with the help of Miller’s Method (see later in the testing section, page 000).

The hyposensitization method aims to find out which substances the patient is allergic to, by giving a whole batch of prick testing, and then to administer injections of a mixture of these, increasing gradually in strength, until quite large amounts are being tolerated. The body is often then found to be able to cope with normal ambient concentrations.

There are two major drawbacks to this hyposensitization treatment:

  • it rarely works and
  • it can be extremely dangerous. Patients sometimes react severely and deaths due to anaphylaxis occured regularly until by common consent its use was abandoned in 1986, except in special circumstances and where full cardio-pulmonary resuscitation equipment is at hand.

The only suitable indications for the use of this method are in cases of perennial rhinitis and asthma due to dust and dust mite allergy, seasonal rhinitis due to pollens and the danger of anaphylaxis due to insect stings. Even so, very brittle (vulnerable) cases, especially children, are better left un-desensitized, since the dangers of the method are very real.

[Note: We have better, safer desensitization methods than this, in the form of enzyme potentiated desensitization (EPD) and Miller’s low-dose desensitization (see Provocation-Neutralization Method)].

 

Patch testing

Another fairly primitive technique is patch testing. Small quantities of different suspected substances are placed under individual cups which are taped to the skin for a number of hours. A reddening of the skin under the patch denotes a sensitivity to that substance. A control is used, since some people react to the pads or tape, etc.

A positive reaction is probably fairy dependable, but it rarely happens. Unfortunately, even substances known to have a marked effect often don’t affect the skin. In other words, negative reactions do not exclude significant allergens.

This method works best for identifying causes of contact dermatitis, such as nickel, soap powders or industrial chemicals.

 

Immunological tests

All other conventional allergy tests are based on immunological reactions of the IgE antibody type. Naturally, classic antigen-antibody reactions are the only results to be expected, which precludes a large number of other allergic and intolerant reactions.

Broadly speaking, then these tests are fine if they give a positive result; which is to say, if an allergy to wheat or egg is found, it exists. Avoiding that food will help with the overall body load. But negatives are meaningless (these occur over 95 per cent of the time). Also, a positive reaction on an immunological test only means antibodies are present, it does not mean the allergy is the one causing symptoms. Experts often overlook this elementary point.

 

The RAST (radio-allergo sorbent) Test

This is the basic immunological test using labeled molecules for quantifying results.

Specific antigen (in this case the allergy being tested) is incubated in contact with a plastic plate or tube until it becomes bound by adsorption (adhesion).

The plate is washed and the patient’s serum, with suspected IgE antibody to that allergy, is added. This naturally locks on to the antigen. Unused sample fluid is washed away, leaving "captured" IgE.

How much IgE antibody has been ‘captured’ is measured by adding a second binding antigen, in this case anti-IgE, which locks onto the IgE in the antigen-antibody complex. This creates an antigen-IgE-antigen "sandwich".

After all un-fixed substances have been washed away, the amount of IgE antibody that remains sandwiched can be measured by a number of tricks. In the basic test, the anti-IgE is labeled with radio active iodine125. After unused labeled molecules have been washed away, the amount that remains behind can be measured using a gamma counter (Geiger counter). Hence: radio-allergo sorbent test.

Another variation called the ELISA test (enzyme-labelled immuno sorbent assay) is to label the anti-IgE with a colour-generating chemical (enzyme). After washing, adding a second enzyme releases the dye. Sensitive spectrometry measures how much colour is now present, hence giving an indication of how much IgE is present.

This approach gives an exquisitely sensitive measurement of how much antibody was present in the serum being tested, using only tiny amounts of test solutions. If the RAST or ELISA test are positive, then antibody is present and a degree of allergy exists to that substance. Very large amounts of IgE mean a bad allergy and a potentially dangerous reaction.

 

Provocation Tests

Conventional allergists share with clinical ecologists a respect for using the patient as his or her own test bed. To administer a substance to the patient to see what happens is called a provocation test. Food and chemical challenge tests are described elsewhere in this section, since they are not used by conventional allergists.

Ophthalmic Testing: Small quantities of test reagent can be placed into the conjunctival sac of the eye. Reactions include visible reddening, lachrymation (tears) and (sometimes) sneezing. There is a limit to the number of substances that can be tested at any one time (i.e., very few) and so this has limited application. It is particularly suitable for seasonal reactions (pollens) being tested out of season.

Nasal Provocation Challenge: Potential allergens can be introduced into the nasal passages, either as liquid or powder particles, and the results monitored. The patient is then observed for an arbitrary 5 to 30 minutes (depending on the standard procedure). Reactions can include sneezing, catarrh, a blocked nose and, naturally a clinical ecologist would ask, cerebral and other manifestations as well. One or two initial sneezes are discounted as being probably just a normal response to the irritating effect of the liquid/powder in the nasal passages.

Alternate nostrils are used and up to 20 items can be tested in one session. If severe symptoms develop, a nasal ‘washout’ using saline (salt water) will normally clear them. It not, testing may have to be discontinued for the day.

Bronchial challenge test: The patient is asked to inhale the test substance into their lungs. It is very dangerous indeed, people have died. No responsible physician should ever administer such a test, yet conventional allergists sometimes do. If you are offered it, refuse outright. Two deaths I know of were attributable to research testing, using this method; the unfortunate patients believed they were helping science.

 

NON-CONVENTIONAL ALLERGY TESTING METHODS

These can generally be classified as the good, the bad and the downright awful. Remember that the value in the test method may lie as much in the treatment which goes with it as the actual technique itself. For that reason I introduce first an entirely scientifically credible testing option which gives good accuracy and leads to a treatment method that has spelled freedom and health for countless patients. I myself have taken over 10,000 people through it over the decades since I was shown it. Conventional allergists fight it tooth and nail, entirely through vested interest. The controversy rages on. You are provided with some references to clinical trials, which you may pursue for yourself.

Miller’s Method (provocation-neutralization)

Also known as serial end-point skin titration, this is the method that enabled me to find some remarkable and obscure allergies, which would otherwise probably have remained hidden.

It was first developed by Carleton Lee of Missouri in the late 1950s. Lee began a series of investigations by injecting his allergy patients with antigens at different concentrations. He noticed something interesting: obviously sometimes he provoked a symptom but sometimes, given a particular dilution, a patient’s symptoms would disappear in just a few minutes, as if by magic. This might happen, eben if the patient had arrived at the office with symptoms! It was one of those lucky situations where the right person is in place, at the right time, to draw useful scientific conclusions. Lee realized immediately that diluting an antigen could make it effective at neutralizing the symptom associated with the allergy.

In fact it emerged that only one specific dilution had this serendipitous effect, which Lee christened the "neutralizing dose"; unfortunately, it was different for each patient (and each allergen) and had to be tested individually. But it was a major advance and offered much symptomatic relief for suffering patients. Herbert Rinkel and others went on to improve Lee’s method and promote its more widespread use, and the first definitive book explaining the technique in detail was written by Joseph B. Miller (Food Allergy: Provocative Testing and Injection Therapy, Charles C. Thomas, Springfield, Illinois, 1972); hence known as Miller's method.

Lee’s widow has (quite rightly) campaigned to have it recognized as the Lee-Miller method. I should also say at this point that Joe Miller is a nice unassuming man and would not dream of purloining a colleague’s eponymous title but that’s the way of the world.

The technique

After testing the control and being assured of the zero baseline reaction, a reagent (food, dust or chemical) is injected superficially into the skin (intracutaneously), making a deliberate wheal. If this grows compared to the control over, say, 10 minutes, this suggests an allergy. The bigger the wheal, the more probable the culprit up to a point. Thus far it looks like scratch or prick testing; but because of the safety factor implicit in the explanation below, we use quite concentrated reagents, which cause foods to show up often, unlike with the scratch or prick method.

Sometimes a symptom is produced (provocation) and this is much more conclusive. Remember these substances are tested one at a time, so there is usually no doubt which caused the symptom.

If a reaction occurs (wheal or symptom), the patient is then given a series of weaker and weaker injections of the same substance at 10-minute intervals until the wheal ceases to grow and the symptom, if there is one, disappears completely.

This 'switch-off' dilution is called the neutralizing dose; it works as a kind of antidote. The procedure is illustrated in figure 001.

Safety note: Because of the ultimate neutralization of the allergic reaction, this method is very safe. Even very unpleasant symptoms are brought rapidly under control by injecting a more dilute dose of the allergen (nearer the end-point). Final adjustment of the correct end-point means that symptoms have vanished altogether. In over half a million test doses I only ever once encountered anaphylaxis, which was blocked by immediate administration of epinephrine (adrenalin). At the time of writing no death has occurred due to Miller’s method, despite its use by thousands of doctors world wide. This is in sharp contrast to the hypo-sensitization method, which caused multiple deaths annually until discontinued.

Nevertheless it is sensible to avoid injecting any substance into a patient who has already had an anaphylactic reaction.

Miller's Provocation-Neutralization Method

The size of the wheal at start is unimportant

After testing a number of substances, a patient can then be given a cocktail of the resulting neutralizing doses. These are administered by self-injection every second day (a simple procedure, easily learned). Some clinics allow patients to take the neutralizing complex sublingually. This has the appeal of being easier and without any discomfort but gives less efficient cover. Sublingual administrations are needed every few hours (just prior to each main meal), which can be a nuisance. The beauty of neutralization is that patients can (usually) go ahead and eat the allergy food. Obviously common sense must play a part and if the reaction is severe, reduced intake may be necessary. But it is better than a life of strict avoidance. Happy patients have found themselves able to eat and drink troublesome items and so rejoin social life on virtually equal terms with the rest of us.

Coordination testing

The method's accuracy can be increased by asking the patient to undertake simple tasks, such as a handwriting demonstration and noting how these change under testing. At the neutralization point the patient's performance should return to normal. More objective determinations can include measuring the patient's pulse rate and blood-pressure.

One important advantage to this method is that the symptom provoked gives the patient a vivid subjective demonstration of each allergen, which helps to fix it in his or her mind. This is far more meaningful than the abstract results of a blood test or some other laboratory report. But remember, not all allergens provoke symptoms.

Another advantage is that a patient with multiple allergies need not be restricted to a very meager diet: allergenic foods can be eaten in moderation, under the umbrella of the 'drops'. Only foods that cause a severe reaction are banned – and the patient may even become desensitized to these by taking the drops and avoiding the food for several months.

Problems

When it works, the method works very well. A number of difficulties may occur, however. About 10 per cent of cases are plagued with shifting end-points. Repeat testing becomes necessary and this is troublesome and may be expensive. These shifts can occur very rapidly. So that by the time the patient is supplied with his or her prescription, it is ineffective. In these cases, even retesting won't help. However, this only applies to less than 5 per cent of those tested.

Unfortunately, the people who need this kind of treatment most, the very sick, 'unstable' patients, are the ones most likely to be troubled by this shifting end-point phenomenon.

Even if the antidotes are not effective, however, the method is still good for diagnosis. It can pinpoint rapidly the worst allergens for a patient. This will help reduce his or her body load. The method is also very safe. Reactions are common but rarely severe, and in any event can be relieved rapidly by the corresponding neutralizing dose. Nevertheless, it would seem prudent to avoid injecting anything into an individual who has experienced a dangerous anaphylactic reaction.

An outstanding feature of this neutralizing technique is that it is usually effective against environmental chemical triggers – no other method is. This makes it superior in my view to enzyme potentiated desensitization.

Hormones

An important special application of Miller's method is in neutralizing hormones. Women tested with oestrogens and progesterone often experience reactions, particularly to progesterone in cases where the woman deteriorates badly health-wise at around her period time. We can hypothesize that these women are allergic to their own hormones (see hormones and allergy).

In fact there are two phenomena we encounter. If the reaction is straightforward and neutralizes easily, this probably represents a true 'allergic' reaction by the woman to her own hormones. But sometimes it can be very difficult or impossible to neutralize a symptom once provoked. We take this to be evidence that the real problem is a hormone imbalance – hormone replacement therapy (HRT) can be considered as a possibility in management.

 

Sublingual provocation and neutralization

A modification of the Miller-Lee technique is to test substances under the tongue (sublingually). A food or other concentrate is placed under the tongue and the reactions noted. If the patient experiences a symptom, this is neutralized, as before, by serial dilutions. The dilution that switches off the symptom completely is taken as the end-point (Dickey, LD Sublingual Use of Allergenic Extracts (monograph) ed. H C King, Elsevier, New York, 1981).

There is no essential difference between this approach and using an injection, although naturally there are fewer parameters by which to judge reactions or the lack of them. Instead of being able to view a wheal, its size and characteristic, the clinician has only the patient's subjective symptoms to rely upon, plus what he or she can observe objectively. Yet with practice it is possible to become quite adept at spotting subtle shifts in the patient's mood or attitude, skin colour, etc. The neutralizing dose would be that which leads the patient to declare his or her symptoms 'switched off' and the clinician to note that whatever manifestations arose have disappeared again.

Obviously, subtle reactions may be missed. Well-masked allergens may not react at all. But the technique is especially suitable for children, many of whom don’t like injections and would not willingly sit for several hours tolerating intracutaneous needles every 10 minutes.

 

Dermal application testing

A further modification of this technique, developed by Drs Jean Munro and Ray Choy in London, is to test substances directly on the skin. This method arose from an observation that probably all clinical ecologists have made form time to time: that an extremely sensitive individual sometimes feels unwell just being in the presence of allergens. Such patients may have to be relocated away from the storage and display areas there test solutions are kept in order that they can be tested.

Munro and Choy were finding that some patients were reacting quite severely to the usual technique and decided to test these patients by simply having them hold a phial of the solution. Even this was too much for some; and so dermal application was resorted to. It was found quite workable.

By placing a dilution of the extract on the skin of, say, the back of the hand, biological and subjective reactions could be provoked and then neutralized by further dermal applications. Sometimes these dilutions may reach 'homoeopathic' levels (i.e. they are very dilute) but still seem to work.

The important safety measure is that if a strong reaction develops, the test solution can be wiped off swiftly.

Controversy

No technique of clinical ecology has been more heavily criticized than Miller's method. Nevertheless, most of us who use it do so because we are aware of its capabilities and accept its scientific validity. More and more papers are being published that show its effectiveness. Yet the controversy won't go away.

Over the years a number of studies have been cited to show that Miller's method is a fake. Almost without exception these have been improperly reported, evidence for key statements has been missing and data has been altered (or withheld) or the protocol so bad that it was obviously designed to invite failure.

In 1973 the Food Allergy Committee of the American College of Allergists, using sublingual provocation testing (see below), carried out a study that showed that the neutralization basis of Miller's method was quite effective. Did they publish their findings? No, they repeated the whole test again in 1974 and this time found that the statistics were not as good. The second study was therefore termed 'The Final Report' while the first positive study was simply cast aside.

The 'Jewett trial' carried our in 1981-83 was appallingly defective. The results remained unpublished for seven years, so clinical ecologists world-wide were deeply shocked when it was suddenly published in August 1990 in the New England Journal of Medicine. This, the world's second most prestigious medical journal, even went to the extraordinary length of issuing a press release announcing that at last the clinical ecologists were going to be sunk. I won't say such spite is without precedent in medicine, but it certainly has no place in a scientific periodical.

To my mind, Miller's method is an outstanding contribution to medicine. Like all medical techniques, it requires skill if it is to be performed correctly.

 

Cytotoxic Tests

This next method sounds closer to the classic antibody blood tests, such as the ELISA. However there are significant differences and it is far from mainstream yet.

Use of a ‘leucocyto-toxic’ reaction for in vitro screening for food allergy antibodies was first recorded by P. Black in 1956. The test at that time was crude and produced results that are best described as suggestive, rather than conclusive. Today’s method follows 30 years of refining this test.

Since 1960 the test has been researched steadily by W.T.K. Bryan and M.P. Bryan at Washington University school of Medicine in St Louis, Missouri. The technique is simple but depends for accuracy upon a high standard of laboratory technique.

White blood cells (leucocytes), separated by centrifuging, are placed on a microscope slide chamber and mixed with about 10 mg of food extract. The sample is then observed at intervals over the next two hours, using a x 60 lens, and the effect of the food extract on the white cells is noted.

Healthy white cells are mobile and exhibit amoeba-like behaviour. On contact with an allergen, in this case a food sample, the cells lose their mobility and become rounded in shape. Cytoplasmic granules become sluggish and cease to stream. Eventually, damaged cells rupture and die. Hence the name for this procedure which is cyto (cell).. toxic (damaging).

A typical test might include several dozen foods, food additives and inhalants such as dust, cigarette smoke and even house gas. Theoretically, hundreds of items at a time can be tested. In practice, the number of items is limited by how many technicians are employed and how many slides they can scrutinize before the samples begin to deteriorate.

Reporting

It is customary to grade reactions from 0 to 4, depending on severity of damage, observing the following changes:

0   reduction or loss of amoeboid movement
1   intracellular stasis (slow-down or stop-page)
2   rounding and distortion of cell contour
3   vacuolation (the appearance of tiny vacuoles, or cavities)
4   cell lysis (bursting open)

Dr. Damien Downing, who first introduced this method into the UK, claims that it has an 80 per cent accuracy. There are many critics however, even among clinical ecologists, who do not take these claims seriously and who point to many well-conducted trials which show that the method is virtually useless. Cytotoxic testing appeared to suffer a mortal blow to its credibility when, for a stunt, journalists sent blood from the same person on the same day and received two widely different reports on the "patient’s" sensitivities.

The difficulty with the test, in common with many other methods, is that it rests in the final analysis on human interpretation rather than objective measurement. This isn’t so bad as long as each laboratory is at least consistent with its own standards. But it may, on occasion, lead to patchy quality in results, which can be very misleading for the patient.

Dr Downing comments on the reproducibility of the test: ‘If the same blood is examined in two separate preparations simultaneously, or in the same preparation by two technicians, or the same blood is examined at 24-hour intervals under controlled conditions, with any single increase in the degrees of freedom, one generally finds that between one in five and one in six of the test results cross the border form one to another of the four possible results. This is presumably a reflection of the technicians’ human limitations. Greater degrees of variability are rare, at around one per cent. That is to say that a technician can manage to, get the result accurate to within one degree of reaction 99 per cent of the time!’

This sounds almost too good to be true, until you remember that in this case each ‘one degree’ of reaction represents 20 per cent of the whole; that means results could be in error by 39% of effect and yet still appear as only "one degree" apart!

Modern test systems, such as the ALCAT or Nutron test claim to get round this element of observer error by using mechanized counting.

Probably the main drawback of the cytotoxic test method is that it needs intelligent and knowledgeable back-up by a competent doctor. Otherwise the patient is left avoiding certain foods indefinitely, with no clear place in mind, struggling to keep up an adequate diet n a selection of things to eat that may be pitifully limited.

Unfortunately, this after-care is not always readily obtainable and the laboratories themselves often duck the issue.

 

Challenge Testing

Eating a portion of food to see if it causes a reaction, or breathing it, is called a challenge test. It is tempting to suppose that these are surely the benchmark of all tests. Why bother with blood tests or skin reactions when you can just use the suck-it-and-see approach? The answer is that a food challenge test is not a very reliable method of testing at all. A person may eat a food one day and feel quite ill, yet on another occasion be able to eat a substantial portion, without any apparent ill effects. Which result would you take as "correct" if this happened on two different test days? Repeating the test many times might increase the accuracy. But this becomes unwieldy; mathematicians will tell us that the patient will need to repeat the test over a hundred times, for the result to become statistically significant! This is onerous indeed, especially bearing in mind the resulting symptoms can take days or even weeks to clear.

You need to read and understand the allergy mechanism called masking, if you have not already grasped this:

The hidden or masked allergy trap is what held back important discoveries in this field until the mid-twentieth century. It is vital to ‘unmask’ an allergy before attempting to do this test, otherwise the results are meaningless. As founding pioneers Randolph, Rinkel and Zeller stated in their book Food Allergy (Charles C. Thomas, Springfield, Illinois, 1951): ‘Actually, the most discerning patient is rarely ever able to detect the presence of a masked food allergy. In fact, the most skilled allergist cannot do so either until he tests for it. Masking may be 100 per cent perfect, even with an individual food test, if steps have not been taken to avoid it’.

To unmask a food you are at present eating you must avoid it for at least four days and preferable five before testing – longer if you suffer from constipation.

Then proceed as follows

  • Test only on a day when you are feeling well. If, for example, you are still undergoing a reaction to a food tested the day before, wait until this clears up before proceeding.
  • Eat only the food you are interested in for the test meal. Spring water and salt (if needed) are permitted, but nothing else. Eat a substantial portion to be sure of provoking a reaction.
  • Eat the food raw or prepared only very simply. Compound foods (mixtures) are not allowed. It is best to use organic produce, free of any chemical contamination if possible. If not, carry out the test anyway.
  • Lunchtime is the best meal. If you use the evening meal it is possible to sleep through any allergic reaction and miss it. It you test at lunch and symptoms occur in the afternoon you can be fairly certain the food was to blame. If there are no symptoms at all you then eat a normal evening meal but include more of the test food. If no symptoms are experienced by next mooring you are justified in treating it as a safe food.
  • It is possible to increase the accuracy of this procedure by including a pulse count. A resting pulse is taken before and after the test meal – actually two or three times afterwards, say 30 and 60 minutes later. By ‘a resting pulse’ I mean that the patient sits still for two minutes before counting it (longer after exertion). A rise or fall of ten or more beats after challenging is considered highly suggestive of an allergy and it is best to avoid such food even if no overt symptoms have developed.
  • It is sensible when testing a food for the first time to smell and taste it before committing yourself. Animals do this all the time" you may notice a dog sniffing and licking any unknown substance before ingesting it. They follow their instincts as to whether or not a substance is safe to eat. Humans can also easily learn to develop this faculty. If when you smell it or taste a little, you get a distinct negative impression don’t make yourself ill by eating the whole portion.
  • If the results of a test are confusing or equivocal repeat the whole procedure but avoid other members of the same botanical or phenolic family: otherwise there may be cross-reactions. If the outcome is still doubtful, treat the food as an allergen. Avoid it for a few months. Then try again.
  • Note: If you experience unpleasant reactions while challenge testing foods you can clear them more rapidly by taking Epsom salts and sodium and potassium bicarbonate mix (see alkali salts therapy).

    Be aware of the fact that it you stay off a food too long, even as little as a few weeks, the reaction could die down and you might miss it.

    Finally, some patients report a ‘build-up’ effect with foods, that is, it may be safe to eat once or even for a whole day, but if eaten more often than this a reaction appears. Stay alert to this possibility. If you feel ill after introducing several new foods and can’t say for sure which was the culprit, this may be the reason. You may need to eliminate all these foods and repeat the tests, taking your challenge foods over several days, just to be sure.

    Foods that cause a build-up effect may be retained in your diet but you must make a point of rotating them carefully so that you don’t eat any individual food more often than every four or five days (see rotation diets).

     

    Chemical challenge testing

    Testing for chemicals is not very different from the procedure recommended for foods. Proceed as follows :

  • Avoid the substance strictly for four or five days. You are more likely to succeed if you eliminate as much chemical pollution as possible prior to testing.
  • Test only on a day you are feeling well. There must be few or no symptoms for the test to be valid.
  • Take your resting pulse before and afterwards, at intervals of 10, 20 and 40 minutes. Observe changes and any subjective symptoms. Note these down. As with food, a rise or fall n pulse rate of more than 10 beats is considered significant.
  • Make sure you come into fresh contact with only one substance in each test. Give yourself a significant exposure, for example three deep breaths, repeating this once after a minute has elapsed.
  • Note : Take care, as this could be dangerous with some chemicals such as ammonia or carbon tetrachloride. For these and similar items it is sufficient to sit a few feet away from a dish or saucer holding about an ounce of the fluid or from a bottle of it with the top removed. As the substance evaporates and diffuses towards you, you will notice the smell first and then the symptom, if there is one.

  • When you have experienced symptoms, cease testing until they have cleared. This may mean no more testing for the day or even for several days.
  • As with food reactions, alkali salts may help the clearing process. Also take substantial doses of vitamin C (up to 20 g).
  • Warning: always tell someone what you are doing and have him or her keep an eye on you. If you pass out during one of these tests you could be in real difficulties. Fortunately, this is rare; but it can happen.

    Tell the other person if you are overcome to simply lay you horizontally, remove the offending substance and open all the doors and windows. If any amount of the substance has been spilled, you must be taken to a different room.

    Discontinue all further tests if this happens. Seek help from a clinical ecologist.

     

    Applied Kinesiology

    This method of testing for allergies usually raises a few medical eyebrows. It has its origins partly in chiropractic and partly in acupuncture and was first described and developed by George Goodheart in the USA. As its name suggests it is primarily concerned with the dynamics of posture and movement . Although it has no proven scientific basis it does seen to be founded on a certain body wisdom. A simpler version for the layman, called Touch for Health, was developed by California practitioner John F. Thie.

    Allergy testing is only a small aspect of this discipline. Applied kinesiology is based on the discovery that if the body is subjected to adverse influences, certain muscles go weak. This can be demonstrated with a high degree of consistency, even if performed double blind – that is with neither the practitioner nor the patient being aware of what is being tested. No-one pretends to know the physiological basis of this effect, simply that it can be shown to exist.

    The explanation lies in the field of energy medicine and I have dealt with it at some length in an earlier book (Virtual Medicine). A partial explanation is also found later in this section, under electro-acupuncture according to Voll (EAV).

    Technique

    The kinesiology practitioner gauges the strength of a group of muscles (techniques exist to improve the tone of weak muscles and generally ‘balance’ the body’s dynamic status before starting). Then, by putting a sample of food under the tongue and retesting, he or she is able to tell whether body. If the muscles weaken significantly, the food is deemed to be an allergen. Actually, those who practice this method say it is only necessary for the patient to hold a bottle or a sample of the substance being tested – the muscles will still go weak, which means non-food substances can be tested also.

    AK, as it is expediently known, probably isn’t as accurate as the more ‘scientific’ methods, but that doesn’t mean it isn’t successful most of the time. Remember it isn’t necessary to identify absolutely every allergy to make someone well. Even if it was only 60 to 70 per cent accurate (and it is probably much better than that when carried out by a skilled practitioner) it is still the most cost-effective testing method of all.

    My main criticism, having dealt with innumerable patients who have been first to a kinesiologist and had a failed or only partial result, is that the majority of AK practitioners are naïve in being unaware that their own body reacts too. So many of these people diagnose "wheat allergy" or "Candida" on virtually everyone who enters their office and never question why. Like all "dowsing" techniques, it’s a case of find what you want to find, unless you take vigorous steps to try and prevent this auto-diagnosis.


    The Auriculo-Cardiac-Reflex Method (ACR)

    Even stranger than applied kinesiology is the auriculo-cardiac-reflex method, developed by French neurosurgeon Paul Nogier and taught widely by Dr Julian Kenyon of the Centre for the Study of Complementary Medicine in Southampton, UK.

    It is based on the fact that stimulation of the sympathetic nervous system causes the rate of maximum pulse amplitude to shift along the artery. Note: this has nothing to do with pulse rate, which does not necessarily alter.

    The test is calibrated as follows: the practitioner rests his or her thumb over the radial artery at the wrist so that the impulse is just out of reach beyond the tip of his or her thumb. A bright light is then shone onto a sympathetically enervated portion of skin, either the earlobe or the back of the hand. This causes the point of maximum amplitude of the pulse to move till it comes directly under the practitioner’s thumb.

    Done properly, it is like feeling nothing until the light shines, at which point the pulse suddenly starts to bump under the counting thumb. This response to light is called a positive reflex.

    Testing foods and other allergens is then simply a matter of holding a filter containing each substance over the skin of the forearm. A positive auriculo-cardiac reflex lasting a dozen or more pulse-beats is a sign of an allergy. If it lasts 20 or more beats, that is a severe allergy.

    With set of filters covering common foods and other allergens, it is possible to test quickly a wide range of substances. Once again, the patient must simply avoid the food but, since only the most pronounced allergens show up, it doesn’t usually lead to a long list of banned substances.

    As with the applied kinesiology method, the ACR technique is a fast and cost-effective means of allergy testing, sacrificing high accuracy for expediency but a very useful method, nonetheless, particularly with children.

     

    Voll Testing

    In Germany in 1952, researcher Reinhold Voll came up with the first device for measuring the electrical resistance of acupuncture points. His system involved over 700 readings on the body, a process that was demanding for both patient and doctor. A simplified procedure has now generally been adopted and is known eponymously as "electro-acupuncture according to Voll" or EAV for short.

    Many electro-acupuncture techniques have been developed since. One of these is the Vega machine, developed by Schimmel and now increasingly in use world-wide. Research into so-called bio-energetic regulatory systems (BER for short) continues apace and BER is rapidly developing into one of the most exciting advances in medical skills.

    The basic Voll machine (known in the US as the Dermatron) is a wheatstone bridge, meaning it checks comparative resistances. The patient holds one electrode in his or her hand while the practitioner uses the other electrode as a probe to touch one of several convenient acupuncture points, usually on the foot. The electrical response results in a read (a swing of the needle, signal if desired). The circuit includes a metallic honeycomb into which phials of different solutions are placed for testing.

    The machine is first calibrated by putting poison, such as a phial of paraquat, into the honeycomb. This produces a ‘disorder read’ (a drop in register); the pathogenic potential of any test substance that gives the same read as paraquat should then be obvious.

    The Voll method is said to be useful in detecting many conditions including stressed organs, early cancer, imbalances and even too much electro-magnetic radiation from living close to high-tension electric cables. Cross-filtering of test phials may enable the ‘stressed’ organ to be identified and a nidus of infection early tumour, etc. – shown as the cause. The machine’s therapeutic potential lies in the fact that a medicine can be tested to see if it eliminates the disorder read before being administered to the patient, inferring it ought to be effective. This development is called remedy testing. The possibilities are fascinating and I described the whole development in great detail in my book Virtual Medicine, Thorsons, London, 1999 ISBN: 0-7225-3823-5).

    From the point of view of this text, the important capability of the Voll method is that it can be used for allergy testing. Obviously, if milk, pork, egg and tomato give the same reading as paraquat, the patient should not eat them! To understand more about the science behind this kind of testing, read the section on Jacques Benveniste’s work, if you have not already done so.

    Such testing can be swift and effective and consequently cheaper than more formal techniques. This means testing is made more accessible to those of limited financial means. Accuracy may not be as high as with some methods, but it is easy to re-check and missed allergens may turn up on subsequent testing. It is even possible to use a Voll machine to evolve ‘neutralizing drops’, as with Miller’s method above. The correct neutralizing dose will be the one that eliminates the disorder read.

    The main drawback is that the machine can prove difficult to use; some people have the ability, others haven’t. Users of the machine emphasize that practice will eventually enable the majority of would-be practitioners to master it. Here we enter the world of mysterious ‘energies’ and even accomplished practitioners find they cannot perform when tired or stressed.
     

    Phenolic Testing

    The EAV technique led to an interesting new development: the subject of phenols in foods. This is a true allergic reaction; thus intradermal testing with chlorogenic acid, a phenol found in green coffee, castor bean and orange, gives a wheal and flare reaction in sensitized individuals that is characteristic Type I hypersensitivity.

    There are many such compounds found in food, based on the phenol (carbolic acid) molecule. The table below lists several common foods and the phenols contained therein.

    Caffeine is an example and is, of course, a poison. In fact most phenolic substances are toxic. How are we able to tolerate them? The answer is, evidently, some people don't!

    Phenolic compounds are the source of color and flavor in foods. Their toxicity may protect the natural plants against micro-organisms. They also help in the dispersal and germination of seeds and attract flower pollinators because of their scent.

    Some individual phenolic compounds have been correlated with specific disorders. Tyramine and nicotine, for example, are implicated in migraine and headaches. A little experience with phenol 'families' leads to new diagnostic skills in allergy. For example, a patient sensitive to cheese, beef, banana and potato might really be sensitive to nicotine.

    Individual phenols can be tested and neutralized using Miller's method (sublingual only, we don’t inject phenols!). Obviously it makes more sense to neutralize the phenol than a whole series of foods, if that is the real problem. Avoidance is another option, where range of related foods is not extensive.

    Note: Many substances are now included in phenolic testing that are not really phenol-based, but the term 'phenolic' persists as an overall generic name for the test procedure.
     

    History and background

    In 1979, Dr. Robert Gardner, Ph. D., professor of Animal Science at Brigham Young University, began to speculate that his own allergies might be caused by a sensitivity to some aromatic compounds found naturally in all plant foods and pollens. He acquired some of these pure compounds, made serial dilutions and started sublingual tests monitoring changes in his own pulse rate.

    He experienced reactions to various extracts and neutralizing doses were found for each compound. Gardner found that neutralizing doses of these compounds would kill his allergic reactions to specific foods. After several months he had succeeded in neutralizing many of his own dietary allergies and he was able to eat most foods without reactions. He experienced a major improvement in his health.

    Foods may contain many different phenols, for instance cow's milk contains 13, tomato 14, cheese and soya 9. Some phenolics are very common: rutin and quercetin are found in almost 100 everyday foods. If you're allergic to cinnamic acid, a common cause of eczema and itching skin, there will 40 common foods that you will react to. You can see that if you were allergic to 2 or 3 phenolics, you could be allergic to dozens of foods!

    Practitioners claim that neutralizing treatment has been particularly successful with infants and children, giving excellent results in cases of autism, mental retardation, hyperactivity (hyperkinetic syndrome), dyslexia, insomnia, enuresis, respiratory allergies, headaches, abdominal pains and asthma.

    In adults, remissions have been achieved in many chronic problems including migraine, fatigue, depression, asthma, arthritis, colitis, hypertension, menstrual disorders, dermatological problems, chronic constipation and cardiac arrhythmias.

    Method

    Those who use the phenolic approach rely diagnostically on an EAV set-up. It is quick, non-invasive and consequently cheap for the individual. It is possible to test over 20 items in a matter of minutes.

    The standard 1:5 dilutions of test reagent are used, exactly as for Miller's method. Neutralizing dilutions tend to run high, up to and exceeding the fortieth dilution (which is virtually unheard of in intradermal testing). In fact it is now advocated that 1:5 series is used only up to about the tenth dilution and a 1:10 from there on, to speed up matters. Children are mostly found to neutralize on lower dilutions, usually between one and twenty.

    Patients return on a monthly basis and receive a 10 cc dropper bottle containing their neutralizing doses and are instructed to take two drops sublingually, three times a day after meals, Upon return the patient is retested and a new neutralizing dilution is administered, which is a almost always lower than the previous one. The aim is to get down to a 'No. 1' dilution (highest concentration), meaning the patient has become tolerant to that particular phenolic.

    The patient is then instructed to take one dose three times a week in order to prevent a recurrence of the original symptoms.

     

    RAST test note

    Interestingly, perhaps remarkably, the benchmark conventional RAST test supports the phenolic hypothesis. Cross-reactions on this test sometimes seem to occur between allergens, not of the same botanical family, but of a common phenol group.

    Finally, there is the possibility that phenolics may protect us in some way. Many foods contain lectins, which should have a severely damaging effect on our gut and indeed the body as a whole – we ought to suffer more than, in practice, we do. Perhaps phenolics are shielding us from lectins? At least one phenolic - rutin (quercitin) - inhibits manufacture and release of histamine and other allergic inflammatory mediators by mast cells and basophils, which is how a true allergic reaction is powered. The drug sodium cromoglycate is used specifically to block mast cell rupture and release of histamine; it is quite similar to quercetin in chemical structure. Maybe these phenols work like drugs, too!

    See also plant toxins section.

     

    Lactose Intolerance Testing

    Three methods may be used, singly or in conjunction:

  • the lactose tolerance test
  • the hydrogen breath test
  • the stool acidity test.
  • These tests can be performed on an outpatient basis at a hospital, clinic, or doctor's office.

    The lactose tolerance test is easy to comprehend. The patients fasts overnight and next day reports to the clinic. He or she if given a drink with a loading dose of lactose. Subsequent blood samples are taken, to see how much glucose appears in the blood. The function of lactase, the enzyme, is to digest lactose and this creates glucose (and galactose, which is then turned into more glucose). If little or no glucose appears in the blood, lactose is not being broken down. Lactose intolerance is thus a lactase deficiency.

    The hydrogen breath test measures the amount of hydrogen in the breath. Normally, very little hydrogen is detectable in exhaled air. However, undigested lactose in the colon is fermented by bacteria, and various gases, including hydrogen, are produced, which travels to the lungs and is exhaled. Raised hydrogen in the breath after administration of a lactose loading dose is thus confirmatory of both lactose intolerance and intestinal bacterial activity. The latter may indicate excessive bacterial overgrowth and dysbiosis, which is a separate issue.

    The stool acidity test relies on the fact that undigested lactose fermented by bacteria in the colon creates lactic acid and other short-chain fatty acids that can be detected in a stool sample. It offers little additional information to the breath test.

     

    Testing Detox Capability

    How your body deals with chemical overload is really a function of the cytochrome p-450 pathway and its enzymes. It would be good to know just how well this system performs in keeping you free of unwanted chemicals and their metabolites.

    Unfortunately, there is no simple way of directly measuring enzyme function. But specialists in the environmental medicine field have been working on the problem and it is now possible to have your detox function estimated by how well it eliminates three challenge chemicals: caffeine, acetaminophen, and salicylate. Before and after saliva specimens are used to check clearance of the challenge substances and an overnight urine sample is tested for the major metabolites of the detoxification process involved and for evidence of lipid peroxidation. These functional assessments provide a comprehensive profile of the body's detoxification capacity and potential susceptibility to oxidative damage.

    A second method is to see what is the total toxic chemical burden your body is carrying. Researchers have been testing this for years. The CDC and EPA have carried out a number of surveys of randomly-chosen individuals. Matters hotted up when in February 2003 two studies were published more or less simultaneously showing we all sequester many chemicals in our tissues. A $200,000 two-year ''Body Burden'' study by the Environmental Working Group and New York's Mt. Sinai Hospital tested 9 individuals for a total of 210 chemicals in their bodies. This was a very small sample but in just nine people 167 different industrial and agricultural chemicals were found, including heavy metals, phosphate and chlorine compounds from insecticides, dioxins and PCBs. What was significant was that individuals dedicated to a holistic and organic chemical-free lifestyle were nevertheless found to have over a hundred xenobiotic substances in their bodies, some of them dangerous. As one of the subjects remarked "We all live in the same chemical neighbourhood".

    A study by the Center for Disease Control, published the same week, looked at a larger and more representative sample of 5,000 random Americans, testing for 116 chemicals. The same gloomy picture emerged. It certainly proves what I have been saying, which is that Nature cannot detoxify some of these alien substances. Our livers and endoplasmic reticulum simply don’t know how to.

    The good news is that this sort of body load estimation is now available commercially; you can find out for yourself what your profile is (see list of addresses in the appendix).

     

    Leaky Gut

    Remember also your gut can be a major source of toxic chemical overload. All blood collected from the intestinal bed goes via the portal vein to the liver. Toxins may include food residues, but also food contaminants, such as pesticides and additives, and reactive oxygen species (damaging free radicals) freed in the process of digestion. All of which puts great strain on the liver’s detox pathways. A leaking gut, which permits a surge of excess toxic matter to reach the liver, seriously increases overload.

    If you do not know the leaky gut model, go here.

    Claude Andre, the leading French researcher into leaky gut syndrome, has established a simple and sensitive screening test, using measurement of the body’s response to two innocuous sugar molecules: mannitol and lactulose.

    Patients with food allergy and suspected leaky gut are fasted and then ingest 5 grams each of mannitol and lactulose. Mannitol, a monosaccharide (small), is passively transported through the intestinal wall and is expected to be present in the blood; around 15% of the dose appears in the urine (range 5-25%). Lactulose on the other hand, a disaccharide (bigger) is not normally absorbed; less than 1% of the administered dose appears in the urine.

    An abnormal result occurs when lactulose appears in significant amounts (over 3% is definitely positive), which means that the gut is allowing through bigger molecules than normal. In fact it is the ratio of lactulose/mannitol which is reported. Normally it should be <0.03. But also if the mannitol decreases this test also infers that malabsorption is taking place. This is a common accompaniment of food allergy and further compromises the nutritional status of a patient who may already be borderline.

    If food allergy is suspected as the cause of either leaky gut or malabsorption, the test is repeated after a defining meal.

     


    Dowsing for allergies

    You may encounter dowsing for allergies. You can tell easily: usually you are asked to supply a lock of hair or some other sample for "testing", through the post. This should not be confused with hair analysis for minerals, carried out by reputable laboratories using a mass spectrograph. which is valid scientifically, though there are probably exaggerated claims. For one thing, these laboratory tests cannot give any information about allergies or even vitamin status from a hair sample. Dowsers claim they can do this.

    There is no scientific footing whatever for dowsing, though that is very far from saying it doesn't work. I myself was taught to dowse by one of the all-time greatest dowsers. Austrian lady, Käthe Bachler, no less! The usual method is to use a pendulum.

    There is no objection to this sort of thing, provided the practitioner makes it clear that he or she uses dowsing as a diagnostic tool (which isn’t usually the case). The cost is generally moderate (about £20). Dowsing centers may attract undue criticism if they call themselves clinics or if the dowsers themselves claim to be medical specialists.

    My caution is that this service is being offered by someone with no medical training, who has no access to proper testing methods and should not therefore be setting themselves up to give advice. Most dowsers, whatever they claim to the contrary, are giving opinions under the guise of dowsing. Many are "detecting" their own allergic problem, without realizing it or perhaps without admitting it. So beware!

    On the plus side, I have carried out Miller's method and other tests by someone dowsed by Käthe Bachler and other good dowsers and found a remarkable concordance.

    Dowsing for geopathic stress is covered under that section.

     

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